Khin Nyein ChanMedical Coordinator

MSF Experience on Use of HIV Viral Load testing

in Myanmar

HIV program in Myanmar

MSF HIV/ART program started since 2003

17 TB/HIV clinics Yangon Region Taninthayi Region Kachin State Shan State Rakhine State

>30,000 patients are on HAART

Waing Maw

Moe Gaung

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Activities HIV Prevention – focusing on SW, MSM, DU

HIV Care and Support including – HTC, PMTCT, OI management, HAART

Laboratory services Network of CD4 facility, 1 Cavidi Viral Load system,

GeneXpert, Biochemistry, etc.

HIV Viral Load monitoring

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MSF installed one Cavidi VL system in Yangon – Mid 2009

HIV Viral Load monitoring (Cont.) Manual Extraction of RT enzyme and

amplification Takes 2 days for one lab tech Leave overnight for final reading

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HIV Viral Load monitoring (Cont.) Final Reading on the next morning

Takes 5 Minutes only

Results obtained through a computer software 29 samples per each run

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Why Cavidi System?

Very feasible for resource limited settings.. Does not require sterile environment/molecular

laboratory Allows for decentralised testing Subtype independent technology Affordable cost

However, Technician dependent Capacity per lab tech: Collection and Transportation of specimen

Capacity of VL monitoring in MSF Max. Capacity using 2 full time lab tech: -

3 runs (87) per week – 156 runs (4524) per year

Current patients on MSF Treatment >29,000 patients on first line Nearly 1000 patients on second line 3 patients on third line

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Country Situation

Estimated patients need of ART – 125,000 Currently on ART - >50,000 2 Viral Load facilities – MSF Cavidi system

and MoH PCR system MSF Criteria for VL testing

1st priority – Clinically and immunologically suspected treatment failure

Yearly monitoring for patients on 2nd line (a rising VL could be targeted with intense adherence counseling)

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Transportation of specimen

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2.5Hr

Boat

6Hr Car

2.5 Hr Air

Viral vs. immunological monitoring

A simple analysis of VL vs CD4 of 3801 patients with suspected immunological failure receiving 1st line ART >1yr shows 20% (755) - confirmed failure and of those failure,

8% (58) has CD4 >350 66% (2505) has undetectable VL and of those 66%,

33%(828) has CD4 <200

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VL: An essential tool in ART package VL should be the first routine

adherence monitoring tool

Support promoting retention on 1st line ART

Critical role in preventing unnecessary switch to 2nd line regimen

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THANK YOU